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JeffNEWS, November 15, 1994
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Generalist Medical Education...
Preparing JMC Students to Be Doctors of the Future
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"At Jefferson Medical College, we believe that preparation for the role
of generalist is fundamental to the education of all physicians," said
Jonathan E. Gottlieb, MD, associate dean for academic affairs and associate
professor of medicine/pulmonary and critical care medicine.
By "generalist," Dr. Gottlieb means the first physician patients bring
their medical problems to - a clinician who has the skills to address a
wide variety of patient problems. Dr. Gottlieb said that despite the
nationally recognized success of Jefferson Medical College's (JMC)
curriculum, we still had opportunities to strengthen our students'
generalist education. Two of these changes instituted earlier are now in
effect.
o A required clerkship in ambulatory care has been in place for years
in the fourth year providing increased exposure to physician role
models and added emphasis on skills and knowledge the generalist
needs. This change was instituted to more effectively nurture and
encourage the enthusiasm and idealism of entering students and
emphasize professional skills and attitudes.
o Before the words "primary care" were on everyone's lips, Jefferson
had already instituted a required family medicine clerkship
INTERNALLY FUNDED PROGRAMS
"The current climate of healthcare reform has inspired more new
initiatives, which are natural extensions of JMC's history and commitment
to excellence," Dr. Gottlieb said. Five new programs the medical college
itself funds are:
o Patient encounter documentation - As economic pressures shift
medical care from the bedside to the outpatient setting, medical
education must shift its focus.
To evaluate the experiences of students with patients in outpatient
settings, a project was undertaken by the Office of Academic Affairs, the
Center for Research in Medical Education and Health Care and the department
of family medicine.
So far, more than 20,000 student encounters with patients have been
recorded, including patient demographics, disease category and severity,
procedures performed, supervision and other data. The results will be used
to correct inconsistencies in clinical material and to document clinical
experiences. In addition, students have received a report comparing their
performance to the class aggregate.
o Early Patient Interaction - Under the direction of James D. Plumb,
MD, assistant professor of family medicine, 60 first-year students
visited medical offices or clinics on six occasions to experience
different aspects of the doctor-patient interaction.
The course aims to sensitize students to what patients expect and
experience when they visit their physicians. Students meet twice with
faculty preceptors in small groups to discuss their observations. The
course has expanded to accommodate 90 students.
o Life Cycle: Doctor-Patient Communication - Four years ago, a
course, "The Life Cycle," was introduced to present the
biological, psychological and social aspects of medicine. An
interdepartmental faculty addresses topics such as violence,
growth and development and the doctor-patient relationship.
This year, a section of the course will be devoted to medical
interviewing, so every student can interview a variety of patients and then
be evaluated. The course emphasizes the skills of effective listening,
information gathering, patient education and fosters compassion,
sensitivity and respect.
o Maternity Continuity Experience - Beginning this year, first-year
medical students can follow a pregnant patient with Jefferson
obstetricians to learn about the physiological, emotional,
cultural and other aspects of pregnancy and childbirth. The
students will also be present at delivery.
In addition, they can follow newborns and their families with primary-
care physicians to emphasize many aspects of primary care.
o January Semester - For three weeks in January, first- and second-
year students have a break from the "major" courses. During this
period, new courses have been introduced emphasizing clinical
judgment, medicine and the law, public health, nutrition, ethics
and health policy, among others. These broad topics are frequently
addressed by primary-care physicians, stressing their importance
as role models for students.
EXTERNALLY FUNDED PROGRAMS
o Commonwealth Generalist Initiative - Last year, Jefferson received
a $150,000 grant from the Commonwealth to develop a plan to increase
the number of generalist physicians in Pennsylvania.
The funds supported faculty in the departments of medicine, family
medicine, pediatrics and obstetrics/gynecology so as to increase the
visibility of generalist role models; for development of a curriculum to
better prepare students for generalist careers; to support generalist
participation in admissions, and to influence clinical experience through
faculty and student support.
Jefferson recently received notification from the Commonwealth of a
three-year, $1.2-million continuation grant, awarded on a competitive
basis, to implement many of the projects described above. This was the
largest award made to any such program in the Commonwealth, according to
Dr. Gottlieb.
o Medical Scholars Program - More than five years ago, a program
was conceived by Joseph S. Gonnella, MD, senior vice president
for academic affairs and dean of Jefferson Medical College, and
others, resulting in an agreement with the University of Delaware.
The agreement assured early medical-school acceptance of Delaware
students to reduce the cost and stress of the application process if the
students met and maintained stringent academic standards. It also shifted
basic medical science courses to the undergraduate years, freeing time
during medical school for special study and experiences in healthcare
systems, medical humanities and self-directed learning. The program also
provides practical and clinical experience during the undergraduate years.
The first Medical Scholars entered Jefferson this fall.
o Health of the Public: Jeff CARES - Under this program, sponsored
by The Pew Charitable Trusts, the Robert Wood Johnson Foundation
and nominally the Rockefeller Foundation, $150,000 has been
awarded to JMC over a three-year period to focus on involvement
of academic medical centers in community health.
Jefferson's proposal includes this focus under the title, Jeff CARES.
"We propose to identify populations in need, including the homeless
(under JeffH.O.P.E.), the Asian population in neighboring Chinatown, the
patients who go to Jefferson's emergency department for their primary
care, and others. A research portion of the proposal aims to determine
the demographics of those served by the department.
o Bridging the Gaps: PCHIP (Philadelphia Community Health Internship
Program) - This program, funded by The Pew Charitable Trusts and
begun at the University of Pennsylvania, focuses on students
having summer experiences in the community with some faculty
supervision. Funding has increased from a few thousand dollars
two years ago to more than $500,000, of which Jefferson's share
was almost $125,000. The program was recently judged by the
Association of American Medical Colleges as a finalist for a
special recognition award.
Project director for Health of the Public: Jeff CARES and Bridging the
Gaps: PCHIP is Sylvia K. Fields, EdD, RN, coordinator, primary care and
community programs, office of academic affairs, JMC.
FUTURE DIRECTIONS
"At Jefferson Medical College, we're fortunate to be able to initiate
different educational experiments simultaneously. The variety of
experiences serves the additional function of allowing each student some
latitude in choosing experiences with particular individual appeal," Dr.
Gottlieb said.
Over time, he noted, it's likely that several major themes will emerge:
increased clinical experience early in medical school; increased emphasis
on self-directed learning, and strengthening of knowledge and skills
fundamental to generalist disciplines.
Stay tuned!
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Information provided by: Editor, JeffNEWS
(215) 955-6204
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